An evaluation of osteoporosis screening tools for the osteoporotic fractures in men (MrOS) study

Summary: No large-scale evaluations of osteoporosis screening tools have been done in men. OST and MOST were examined among 4658 US Caucasian and 1914 Hong Kong Chinese men. Both tools have high negative predictive values, accurately screening out men with low risk, and saving a third of DXA tests. Introduction: Prior investigations have studied the performance of osteoporosis screening tools in women, but no large-scale evaluations have been done in men. Methods: This study examines the performance of the Osteoporosis Self-assessment Tool (OST), the Male Osteoporosis Screening Tool (MOST), quantitative ultrasound index (QUI), and body weight as screening tools. Osteoporosis was defined by a dual-energy X-ray absorptiometry (DXA) measured bone mineral density (BMD) T-score ≤-2.5. Four thousand six hundred and fifty-eight US Caucasian and 1914 Hong Kong Chinese men, aged ≥65 years and community-dwelling, were included in the analysis. Receiver operating characteristic (ROC) analysis was used to compare the area under the ROC curve (AUC) between different screening tools. Results: MOST had a significantly larger AUC (≥0.8) than OST, QUI, and body weight in detecting osteoporosis. Using the second tertile as cutoff, OST and MOST yielded sensitivities of around 90% and negative predictive values (NPVs) of >97%, accurately screening out Caucasian and Chinese men with low risk of osteoporosis. Conclusions: OST and MOST can effectively rule out osteoporosis for both Caucasian and Chinese men, and compared to referring men 65 years and older for BMD DXA testing, they save a third of DXA resources.